The Centers for Disease Control (CDC) has identified falls-related traumatic brain injury (TBI) in older adults as a significant and unrecognized public health issue;with 8000 deaths from falls- related TBI in older adults and 56,000 hospitalizations, at a mean cost of $16,006/$19,191 for women/men >64 years reported in 2005;prompting a public service campaign4. The challenges of maintaining independence in mobility and physiologic conditioning for wellness while avoiding injury due to impaired balance can contribute to the downward spiraling to frailty and loss of independence. The very deficits associated with many chronic conditions with aging that lead to mobility and balance difficulties, often contribute to cognitive changes that limit the effectiveness of rehabilitation and safety training and overall awareness of self-limitations15. Some of the increase incidence in and mortality from TBI is associated with anticoagulation therapy, including aspirin and the 2 million new users of warfarin each year12. To address this challenge, with the support of NIH Phase I SBIR funds, a new lightweight, un-obtrusive medical headgear with over 90% impact force reduction using was developed using advanced composites. The goal of the research component of the Phase II proposal is to 1) optimize material characteristics using data from Phase I impact testing and conduct numerical modeling using finite element analysis, 2) conduct biochemical evaluation of these advanced materials on designer-enhanced prototypes, 3) perform clinical trials with qualitative analysis based on indepth interviews and focus groups on patients, family members and staff to develop tools to evaluate compliance and decisions to use the product and 4) Develop a standard for headgear protection for patients at risk of same level falls. PUBLIC HEALTH RELEVANCE: Falls-related traumatic brain injury has become a significant and unrecognized public health issue. There is a need for a new lightweight, attractive, unobtrusive medical headgear that can be customized to the style, needs, comfort and protection to provide higher compliance and application to patient populations that includes older adults with balance impairment, dementia, active seniors on blood thinners, acute care hospital cases at very high risk for falls to reduce the health consequences of falls-related traumatic brain injury. Outcomes tools to evaluate the effectiveness of social marketing and academic detailing will be developed.